Bone Marrow Transplant

Bone Marrow Transplant Process

• Preparing for Transplant
• Transplant

Once a patient has been identified as a candidate for bone marrow transplant (BMT), arrangements will be made for scheduling the procedure. During this period, patients are encouraged to build up their strength with safe and suitable activities recommended by their physicians. Appropriate exercise and nutrition can play an important role in preparing for and recovering from BMT.

Preparing for Transplant

The Health Care Team
In order for patients and their doctors to determine if transplant is the right treatment, patients will meet with several people to assist in their education of the BMT process. The members of the healthcare team will be in contact with the patient before, during, and after the hospital stay. They will describe the treatment plan and any changes that become necessary. They will offer support and try to answer any questions the patient or caregiver might have. We encourage patients to ask questions so they understand the reason for all of the treatments and procedures they encounter. At Mayo Clinic, the patient and family are vital members of the healthcare team.

The health care team includes the following individuals:

• Physicians specializing in hematology (the study and treatment of blood and blood diseases), oncology (the study and treatment of cancer) and transplant. These physicians oversee all care and treatment patients receive. They may consult with the patient's local physician before and after transplant.
• BMT scheduling coordinators contact patients early and assist patients as pre-transplant evaluation tests are scheduled. They help to explain the schedule of tests and make changes as needed.
• BMT nurse coordinators have expert BMT knowledge from the inpatient and outpatient perspective. They will assist with education and organizing the patient's plan of care.
• Transfusion medicine/apheresis nurses provide technical support while progenitor cells are being collected.
• Nurse practitioners have advanced training in hematology, oncology and bone marrow transplants, and work closely with the physicians.
• Clinical nurse specialists have specialized education, experience and knowledge in BMT and may assist the patient and family with resources for coping with the transplant experience.
• Registered nurses help coordinate and provide care in the hospital and outpatient setting. They have experience and knowledge in working in this specialized area.
• Social workers may meet with patients to discuss concerns regarding insurance coverage, local housing, transportation and other financial concerns.
• Nutritionists and dietitians work with the physicians to assess the patient's nutritional status.
• Chaplains offer counseling in spiritual issues, help in ethical decision making, and offer opportunities to share in the formal rituals of faith.

Pre-transplant Screening Tests
Before undergoing BMT, patients have a series of tests and procedures for screening and preparation. The testing schedule is based on the patient's disease process and medical history. These tests and procedures may include:

• blood tests to measure kidney, liver, heart, lung and hormone function
• blood tests to screen for infections
• bone marrow evaluation
• X-rays and computer-assisted tomography (CT) scans
• lumbar puncture (spinal tap)
• physical exam
• dental examination
• psychological evaluation
• placement of a central venous catheter

Pre-transplant Education
Patients and their caregivers will meet with a transplant physician and a BMT nurse coordinator to discuss the results of the testing, treatment options and the treatment plan. Touring areas where BMT patients are treated is an important part of the pre-transplant education phase. To familiarize themselves with these areas, patients and their caregivers may tour the hospital bone marrow transplant unit, the outpatient chemotherapy unit, the apheresis unit and the radiation oncology area. During this tour, staff from each area will explain their role in the treatment plan. Patients and caregivers are encouraged to ask questions.

Transplant Conditioning
The goal of transplant conditioning is to destroy abnormal cells or cancer cells throughout the patient's body. The conditioning regimen is based on the type of disease, previous treatment, and clinical trial participation. It may consist of chemotherapy, radiation therapy or both. Radiation may be given before the transplant as part of the conditioning regimen, or it may be given following recovery from transplant.

Transplant

Blood and Marrow Stem Cell Donation
The harvest procedures for autologous or allogeneic BMT are similar. The timing of the blood or bone marrow harvest depends on such factors as the patient's physical condition, donor availability and insurance approval.

Peripheral blood stem cells are obtained through a process called apheresis, which separates blood into its different components. Before and during apheresis, the donor will receive daily injections of protein growth factors to help stimulate bone marrow to make new white blood cells. Hospitalization is not necessary during this procedure. Stem cells collected by apheresis can then be frozen for later use.

Donors of bone marrow typically enter the hospital the morning of the donation. The donation is taken in the operating room under general anesthesia. Because general anesthesia is used, donors may remain in the hospital overnight for observation. Most donors' bodies will replace the donated marrow within two or three weeks. Healthy bone marrow may be frozen for storage and transplanted later.

Outpatient Management vs. Hospitalization
It is possible for a patient to begin the collection process, receive chemotherapy and be managed as an outpatient for the duration of his or her care. Hospitalization during transplant is not required. Factors that determine the need for hospitalization include:

• Patient's physical status and disease process
• Conditioning regimen
• Caregiver availability

However, the patient and caregiver must remain within 30 minutes' traveling time to the hospital once chemotherapy has been started. Many housing options are available including hotels, RV sites and transplant houses. If treated as an outpatient, a patient is seen daily, seven days a week, on the BMT unit. There, the patient receives necessary treatments including blood transfusions, antibiotics, intravenous fluids and nutrition.

Length of Stay
How long patients need to remain near Mayo Clinic depends on a variety of factors which include:

• When the transplanted marrow "engrafts" and begins producing healthy blood cells
• Patients' need for red blood cell and platelet transfusions
• Their calorie intake
• Their level of independence and ability to perform daily self-care
• Their level of support from caregivers at home

A patient can expect to remain near Mayo Clinic for six to eight weeks, depending on the treatment plan.

Follow-up
After a patient has returned home, follow-up appointments at Mayo Clinic are needed periodically. These visits will take from one to four days to complete. During these follow-up visits, Mayo Clinic staff will perform tests to evaluate how well the treatment is working.